Healthcare Provider Details

I. General information

NPI: 1679110530
Provider Name (Legal Business Name): NEW MEXICO SLEEP LABS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2019
Last Update Date: 03/24/2022
Certification Date: 03/24/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1651 GALISTEO ST STE 11
SANTA FE NM
87505-2113
US

IV. Provider business mailing address

1016 QUINTA ANTIGUA LN
EL PASO TX
79912-2039
US

V. Phone/Fax

Practice location:
  • Phone: 915-779-7378
  • Fax: 915-779-2822
Mailing address:
  • Phone: 915-779-3778
  • Fax: 915-779-2822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207RS0012X
TaxonomySleep Medicine (Internal Medicine) Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QS1200X
TaxonomySleep Disorder Diagnostic Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: GONZALO DIAZ
Title or Position: OWNER
Credential: MD
Phone: 915-779-7378